June 19, 2013
Hospital, Doctor Shopping Isn’t Easy For Patients Looking To Compare Prices Of Health Care Services
State websites that publicly report health service prices rarely provide information that is relevant or usable for consumers
When it comes to shopping for health care services, few publicly available tools help patients measure the best bang for their buck, according to a new study in the Journal of the American Medical Association (JAMA).
The federal government recently shone a light on health care prices by releasing hospitals' charges for procedures and services — but that kind of information won't likely help consumers trying to compare their care options, say authors of the study led by an expert from the VA Center for Clinical Management Research and the University of Michigan Health System.
A rigorous analysis of 62 publicly available state websites that aim to help patients to estimate or compare prices for health care services found that most sites only reported billed charges, not what patients were actually expected to pay.
The study also found that most websites focused on prices for in-hospital care, which patients often don't have the luxury to plan ahead for. Meanwhile, sites rarely included prices for outpatient services like laboratory or radiology tests that are often predictable or less urgent, and therefore more shoppable. Experts also found that most patient resources didn't provide information on quality of services alongside price information in situations where variations in price could be tied to differences in quality.
"There's growing enthusiasm for improving transparency of prices for health services to help people be well-informed consumers and make better decisions about their care. The problem is that most of the information that's out there isn't particularly useful to the patients themselves," says lead author Jeffrey T. Kullgren, M.D., M.S., M.P.H., health services researcher in the VA Center for Clinical Management Research and the division of general medicine in the U-M Medical School.
"As more Americans face high levels of cost-sharing in their insurance plans, it's even more important to improve access to data that help them anticipate their out-of-pocket expenses and evaluate their options."
People with chronic conditions who face high levels of cost-sharing would especially benefit from the ability to compare their out-of-pocket costs for different services, Kullgren notes. For example, a patient with diabetes who is enrolled in a high-deductible health plan may undergo several routine tests a year and has time to estimate and compare prices for those services ahead of time.
Most of the public websites analyzed, however, focused on reporting prices for in-hospital services that are often used to treat urgent, sometimes life-threatening conditions.
"Obviously if you have a heart attack or another emergency that sends you to the hospital, you're not going to be researching prices of services ahead of time," Kullgren says. "But if you know you're due for a routine lab test, a radiology test, or an outpatient procedure that you will have to pay for, you often have time to assess the options. Unfortunately prices for those types of services are seldom available."
Kullgren and his colleagues evaluated websites run by state-specific institutions such as state government agencies or hospital associations. The number of websites offering information on health care prices steadily rose from 2000-2012, and more than half of them launched after 2006.
Some sites, such as the New Hampshire HealthCost website, stood out as bright examples of how consumer-friendly data can be shared. The website allows patients to plug in their health insurance plan to receive a customized estimate of what certain health care services would cost them at different facilities in their community. But such instances are rare and often arise from specific state legislation that dictates the types of information that state governments collect from health care providers and publicly report, Kullgren says.
"We've definitely come a long way in increasing transparency about cost and quality for consumers in the last decade, but we're still not reporting the key information patients need to maximize the value of their health care spending," Kullgren says. "We aimed to identify opportunities for improvement so that we can better empower people to choose the care that's right for them."
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